Provider Demographics
NPI:1851363535
Name:TOUSSAINT, VINCENT S (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:S
Last Name:TOUSSAINT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325
Mailing Address - Country:US
Mailing Address - Phone:864-833-5963
Mailing Address - Fax:864-833-5960
Practice Address - Street 1:103 MISSISSIPPI DRIVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-833-5963
Practice Address - Fax:864-833-5960
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC08464208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC084642Medicaid
SC084642Medicaid
SC$$$$$$$$$OtherEIN
SCB91713Medicare UPIN